Ramblings of an Emergency Physician in Texas

An excellent primer on deckplate things to do to prevent, and what to do if you think you have, the flu. I’m linking it as I like this nice bit of perspective:

Political vaccination (bloodletting.blog-city.com)…
Let me also say that this is a situation where perception becomes reality. People who would otherwise not even seek out a flu shot, balking at the fifteen dollar cost, now are in hysterics trying to get vaccinated, forking over hundreds of dollars, and putting their lives at risk to do so. Because everyone now wants a vaccine that they normally wouldn’t the demand has increased. Since the supply is effectively frozen, the shortage is much more felt. So, the shortage is self-reinforcing.

On the 15th I blogged about research showing that Metered Dose Inhalers (MDI’s) are commonly misunderstood, and that there is no easy way to figure out if they’re empty.

This took me completely by surprise, as I thought the ‘float test’ was an accurate way to tell if medication remained, but the article said it wasn’t, the only way to be safe was to count down the number of doses expected to be in the container, and discard it when empty.

SO, I got a little time to go check on it today, and from the MDConsult drug reference, under “Information for Patients”:

…Discard the canister after 200 sprays have been used or 3 months after removal from the moisture-protective foil pouch, whichever comes first. Never immerse the canister into water to determine how full the canister is (“float test”).

and boy do I feel silly, as I thought the float test worked.

(The float test came about over one of the big frustrations of MDI’s: they have more propellant than medication, and thus will keep right on spraying medically useless propellant into the patients’ lungs instead of meds and propellant).

There’s a cautionary tale here: I was taught the float test as a pup, and it’s not unreasonable to think it would work. It makes intuitive sense and when I’ve had a patient bring in an obviously empty inhaler and floated it, the demonstration ‘worked’. Medicine has several of these ‘things everybody knows’ that are wrong.

So: no more float tests, and tell the patient taking albuterol (salbutamol for the non-US part of the world) to count backward from 200 doses (and remember!), then throw the canister away, and get a refill.